Abstract
Background
Lumbar disc herniation (LDH) results in low back pain due to nerve root compression
caused by nucleus pulposus degeneration. Chemonucleolysis of the nucleus pulposus
by injection of condoliase is less invasive than surgery, but may cause disc degeneration.
The purpose of the study was to examine outcomes of condoliase injection in patients
in their teens and twenties using Pfirrmann criteria on MRI.
Methods
A single-center retrospective study was performed in 26 consecutive patients (19 men,
7 women) who underwent condoliase injection (1 mL, 1.25 U/mL) for LDH and had MRI
scans at 3 and 6 months. Cases with and without an increase in Pfirrmann grade at
3 months post-injection were included in groups D (disc degeneration, n = 16) and
N (no degeneration, n = 10). Pain was measured on a visual analogue scale (VAS). MRI
findings were evaluated using the % change in disc height index (ΔDHI).
Results
The mean age of the patients was 21.1 ± 4.1 years and 12 were <20 years old. At baseline,
4, 21 and 1 were in Pfirrmann grades II, III and IV. In group D, no case had a further
increase in Pfirrmann grade from 3 to 6 months. Pain significantly decreased in both
groups. There were no adverse events. MRI showed a significant decrease in ΔDHI from
100% pre-injection to 89.4 ± 9.7% at 3 months in all cases (p < 0.05). There was a
significant recovery in ΔDHI in group D from 3 to 6 months (85.4 ± 9.3% vs. 86.7 ± 9.1%,
p < 0.05).
Conclusions
These results suggest that chemonucleolysis with condoliase is effective and safe
for LDH in young patients. Progression of Pfirrmann criteria at 3 months post-injection
occurred in 61.5% of cases, but disc degeneration showed recovery in these patients.
A longer-term study of the clinical symptoms related to these changes is required.
Keywords
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Article info
Publication history
Published online: March 04, 2023
Accepted:
February 18,
2023
Received in revised form:
February 8,
2023
Received:
October 12,
2022
Publication stage
In Press Corrected ProofIdentification
Copyright
© 2023 Published by Elsevier B.V. on behalf of The Japanese Orthopaedic Association.
